TABLE 2.

Research Priorities for Palliative Care in Surgery

Research Priority	Study Objective	Study Setting	Sample	Study Design
Defining outcomes that matter to patients
Develop and validate instruments for patientreported measures of palliative out omes relevant to surgical patient populations	Evaluate patient-reported outcome measures that reflect palliative care in surgery	Outpatient, inpatient, ICU,home	Patients who have major surgery and their caregivers	Qualitative and mixed method studies; psychometric research
Develop and validate palliative care process measures for surgeryspecific palli tive care delivery and ACP	Develop measurable processes of care to deliver high quality palliative care to surgical patients	Outpatient, inpatient, ICU	Seriously ill surgical patients and their caregivers	Randomized controlled trials; quasiexperimental studies; cohort studies
Communication and decision making
Determine the effectiveness and comparative effectiveness of communication interventions versus usual care	Evaluate interventions to improve perioperative decision making and align surgical treatments with outcomes patients value	Outpatient, inpatient,emergency room	Patients with serious illness and caregivers who are considering major surgery	Randomized controlled trials; Prospective and retrospective studies; quasiexperimental designs
Design and conduct large, multicenter trials assessing effectiveness of communication tools to disclose prognosis in the perioperative period.	Reduce conflict (between clinical team and family and among the clinical team) and burdensome interventions that are not aligned with patients’ goals for care in the postoperative period	Inpatient, emergency room, ICU	Patients who experience complications and their families	Randomized controlled trials; prospective and retrospective studies; quasiexperimental designs
Delivery of palliative care to surgical patients
Develop and test models for integrating palliative care into routine management of seriously ill surgical patients	Increase acceptance and utilization of palliative care in surgical culture and practice	Academic centers and community hospitals	Surgical clinicians (ie, surgeons, nurses, anesthesiologists)	Randomized controlled trials; prospective and retrospective studies; quasi-experimental designs
Determine effectiveness and comparative effectiveness of targeted early versus late palliative care on healthcare cost, symptom management, quality of life, and caregiver burden	Increase timeliness of palliative care interventions for surgical patients with complex palliative care needs	Community, outpatient, inpatient	Surgical patients with poor prognosis and their caregivers	Randomized controlled trials; prospective and retrospective studies; quasi-experimental designs
Design and conduct large, multisite studies to compare palliative surgery versus medical management on symptom burden and quality of life.	Examine the effect of palliative surgical procedures on patientreported outcomes	Outpatient, inpatient	Patients with oncologic, vascular, cardiac surgical problems, and their caregivers	Mixed-methods studies; randomized controlled trials; prospective and retrospective studies; quasiexperimental designs

ACP indicates advance care planning; DNR, do-not-resuscitate; ICU, intensive care unit; LST, life-sustaining treatment.